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Burns, Jacob; Movsisyan, Ani; Stratil, Jan M.; Coenen, Michaela; Emmert-Fees, Karl M. F.; Geffert, Karin; Hoffmann, Sabine; Horstick, Olaf; Laxy, Michael; Pfadenhauer, Lisa M.; Philipsborn, Peter von; Sell, Kerstin; Voss, Stephan; Rehfuess, Eva Annette (2020): Travel-related control measures to contain the COVID-19 pandemic: a rapid review. In: Cochrane Database of Systematic Reviews, Vol. 10, No. 9, CD013717: pp. 1-160
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Background In late 2019, first cases of coronavirus disease 2019, or COVID‐19, caused by the novel coronavirus SARS‐CoV‐2, were reported in Wuhan, China. Subsequently COVID‐19 spread rapidly around the world. To contain the ensuing pandemic, numerous countries have implemented control measures related to international travel, including border closures, partial travel restrictions, entry or exit screening, and quarantine of travellers. Objectives To assess the effectiveness of travel‐related control measures during the COVID‐19 pandemic on infectious disease and screening‐related outcomes. Search methods We searched MEDLINE, Embase and COVID‐19‐specific databases, including the WHO Global Database on COVID‐19 Research, the Cochrane COVID‐19 Study Register, and the CDC COVID‐19 Research Database on 26 June 2020. We also conducted backward‐citation searches with existing reviews. Selection criteria We considered experimental, quasi‐experimental, observational and modelling studies assessing the effects of travel‐related control measures affecting human travel across national borders during the COVID‐19 pandemic. We also included studies concerned with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) as indirect evidence. Primary outcomes were cases avoided, cases detected and a shift in epidemic development due to the measures. Secondary outcomes were other infectious disease transmission outcomes, healthcare utilisation, resource requirements and adverse effects if identified in studies assessing at least one primary outcome. Data collection and analysis One review author screened titles and abstracts; all excluded abstracts were screened in duplicate. Two review authors independently screened full texts. One review author extracted data, assessed risk of bias and appraised study quality. At least one additional review author checked for correctness of all data reported in the 'Risk of bias' assessment, quality appraisal and data synthesis. For assessing the risk of bias and quality of included studies, we used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS‐2) tool for observational studies concerned with screening, ROBINS‐I for observational ecological studies and a bespoke tool for modelling studies. We synthesised findings narratively. One review author assessed certainty of evidence with GRADE, and the review author team discussed ratings. Main results We included 40 records reporting on 36 unique studies. We found 17 modelling studies, 7 observational screening studies and one observational ecological study on COVID‐19, four modelling and six observational studies on SARS, and one modelling study on SARS and MERS, covering a variety of settings and epidemic stages. Most studies compared travel‐related control measures against a counterfactual scenario in which the intervention measure was not implemented. However, some modelling studies described additional comparator scenarios, such as different levels of travel restrictions, or a combination of measures. There were concerns with the quality of many modelling studies and the risk of bias of observational studies. Many modelling studies used potentially inappropriate assumptions about the structure and input parameters of models, and failed to adequately assess uncertainty. Concerns with observational screening studies commonly related to the reference test and the flow of the screening process.